1. Patient Advisor Rounding Vidant Medical Center Kim Blanton Patient & Family Advisor Melissa Thomason Patient & Family Advisor

2. 1 What you will learn today  What are Advisor Rounds?  Why are they important?  How do you do Advisor Rounds?  Tools to support successful rounding  Impact of Advisor Rounding  Lessons learned

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4. System of Care 3

5. A Day in the Life of Vidant Health  196 acute care admissions  136 surgeries  118 critical care patient  822 ED visits  1,377 outpatient visits  2,000 VMG practice visits  7 medical air transports  21 babies born  184 patients with central lines  78 patients on ventilators  144 patients with urinary catheters 4

6. Patients & Families as Team Members & Leaders “Put Patients and Families on the Improvement Team” is noted as the leverage point with the greatest potential to drive the long-term transformation of the entire system.” IHI Seven Leadership Leverage Points to Drive Organizational Improvement 2008 IHI innovation series

7. System Wide Advisor Structure Vidant Bertie Hospital Advisory Council Vidant Chowan Hospital Advisory Council Vidant Medical Center Advisory Council Vidant Duplin Hospital Advisory Council Vidant Edgecombe Hospital Advisory Council Vidant Roanoke- Chowan Hospital Advisory Council Albermarle Hospital Advisory Council The Outer Banks Hospital Advisory Council Vidant Beaufort Hospital Advisory Council (To be Developed) Vidant Pungo Hospital Advisory Council To be developed Vidant Employee Health Advisory Council Vidant Home Health And Hospice Advisory Council Vidant Medical Group Advisory Councils Vidant SurgiCenter Advisory Council Vidant Medical Center Service Line Advisory Councils VIDANT HEALTH PATIENT-FAMILY EXPERIENCE TEAM 6

8. 7 Vidant Medical Center

9. Vidant Medical Center Advisor Structure Vidant Health’s commitment is to have advisors at decision-making tables and to view care through the eyes of the patient. 8

10. Patient and Family Advisors Any role or activity that enables patients and families to have direct input on policies, programs, and practices affecting health care.

11. What do VMC Patient Advisors do? Patient & Family Advisors Education Literature Review Safety Rounding Facility Design Quality & Performance Improvement Teams System Input Patient Communication & Transparency Storytelling *Unit Rounds *Return to Care Rounds *Safety Liaisons Safety Summit Safety Boot Camp RCAs FMEAs Falls UTI Skin CLABSI VAP MyChart Care Coordination Board Presentations “Experiences in Care” Videos Conferences New Nurse Orientation Provider Education Patient Education Staff Education REAL DEAL training Children’s ED Cancer Center Children’s Hospital Heart Institute Hiring Committees Strategic Planning Vendor Selection

12. WHY Should Advisors do Rounds?  A real-time pulse check  Strengthens partnerships  Some patients are more comfortable sharing concerns with a “former patient”  Introduces a fresh perspective  Front line workers see PFCC in ACTION  Drives results. Yields better outcomes.

13. Vidant Medical Center Safety Liaisons 12  Patient & Family Advisors who have completed risk assessments, HIPPA training and role orientation.  Patients give consent in advance.  Liaisons focus on safety and use a rounding tool.  Findings are documented and staff and advisors conduct debriefs with safety manager.

14. Pre – Safety Round Patient Consent Form

16. Safety Liaison Rounds: What we learned… …. about Advisor Rounding  Advisor Selection Important  Builds Relationships  Some patients more comfortable sharing with Patient Advisors than with Staff …. about our Care System  Identified transition snags from acute to rehab  Room nightlight preventive maintenance process missing  Discharge instructions in bright envelope; being used throughout the system  Patient-family engagement in bedside shift report, hourly rounds and communication boards

17. Return to Care Rounds 16  Advisors rounded with leaders from Office of Patient & Family Experience  Used separate rounding tools and compared results after each room  Hospital – wide results compiled by Office of Patient & Family Experience

18. Service Line Rounds 17 “ That’s what made a believer out of me….” Diane Hatfield East Carolina Heart Institute Quality Chair

19. 18 Cardiac Intensive Care Unit CICU Cardiac Intermediate Unit CIU Cardiovascular Intermediate Unit CVIU Unit Rounds CVIU and CVIC Cardiovascular Intensive Care Unit CVIC

20. HOW do we do Unit Rounds? 19  Meet with Unit Manager  Review Unit Scores  Identify Unit’s Needs (based on scores, manager’s needs & advisor’s input)  Round with Managers  Discuss Advisor Rounding Alone  Report Findings to Unit Manager  Act on Findings

21. A Success Story: CVICU 20 From CVICU Rounds: 1. “Patient does not understand purpose behind the only new med she has received since admission” 2. “No staff member has ever removed the “Commonly Used Meds” sheet from the boom for any reason.” Unit Needs: Med Communication Nurse Communication

22. Act on Findings 21 1. TEAM strategy session 2. Small tests of change 3. Round to assess effectiveness 4. Make Improvements 5. Continue Rounding One piece of the puzzle: RESULTS: CVICU Med Communication score rose from sub 10% to 98% within a year.

23. A Success Story: CIU 22 “Wife stayed with husband for entire admission of 40+ days and was overwhelmed by the care she received as a family member. Nurses offered her extra meal plates at every meal time and checked on her regularly.”

24. Act on Findings 23 1.Advisor and Wife immediately recognized nurse on duty 2.Advisor reported findings to Unit Manager at end of Rounds 3.Unit Manager and Advisor gave Wife Employee Recognition form 4.Form copies added to personnel files 5.Nurses received Staff Reward Points

25. Round, Round, Round …

26. VMC Outcomes  58% reduction in hospital acquired infections (HAI) since 2008  95% optimal care on core measures (up 17 percentage points since 2007)  90 th percentile inpatient experience  Tripled number of patient-family advisors in less than two years  Hardwired hourly rounding, bedside shift report and communication boards  Nearly 90% of staff report organization demonstrates commitment to patient-family centered care 25

27. Advisor Rounding: Impact  Strengthened Partnerships  Advisor impact no longer dependent on presence of Patient Experience Team leaders  Boosted Patient Morale  Boosted front-line staff support  Made managers more open to Advisor input  Increased Advisor satisfaction  Improved scores & outcomes 26

28. Lessons Learned  Not every manager is open to Advisor Rounding. Start small.  Not every Advisor will want to Round. Advisor selection matters.  Rounding requires mutual respect and open communication between Advisors and Managers.  Build on existing work. Don’t reinvent the wheel. Keep it simple!

29. 28 What can I do today? Leader Rounds + Experienced Advisors ADVISOR ROUNDING “I love to round with advisors. It is the best thing a manager can do for her unit.” Elaine Clark Manager, Women’s & Children’s

30. 29 Kim Blanton Patient-Family Advisor, Vidant Medical Center blakimsab@embarqmail.com 252.830.1794 Melissa Thomason Patient-Family Advisor, Vidant Medical Center mthomason@embarqmail.com 252.886.2864 for more information contact